Dysphagia and Breastfeeding

Symptoms of Dysphagia in Breastfed Infants

Images of parents happily breastfeeding their infants, smiling as they look down on their little one, are portrayed all over the media. However, not every breastfeeding experience is quite so picturesque. What is not so often talked about, but is unfortunately quite common, is the challenge and uncertainty that may come with breastfeeding. Many things, like the physical or mental health of the breastfeeding parent or the medical conditions of the breastfeeding infant, can cause breastfeeding to be more difficult than what a parent might have imagined. 

One medical condition that can cause breastfeeding challenges is abnormal swallowing function of the infant, or pediatric dysphagia. While medical imaging is needed to diagnose dysphagia, as well as to differentiate it from other medical conditions causing feeding and swallowing difficulties (i.e., cleft palate), there are many symptoms of dysphagia in breastfeeding infants that are apparent without medical imaging. Below is a list of symptoms that may be indicative of dysphagia in a breastfed infant:

• Falling asleep during feeds [1]
• Excessive drooling [1]
• Coughing [1]
• Flaring of the nostrils [1]

• Taking a long time to feed [2]
• Fussiness during feeds or refusing the breast all together [2]
• Gurgly sounding voice [2]
• Vomiting [2]

• Gagging [3]
• Noticeable breathing changes during feeds [4]
• Milk spilling out of the mouth or nose while at the breast [4]
• Signs of pain or stress during feeds (i.e. hands spread wide, furrowed brow, or turning away) [4]

It is important to note that while the above symptoms are characteristic of dysphagia, they are not distinguishing. This means that an infant may display any of the above symptoms due to something other than dysphagia. For example, while coughing is a common symptom of dysphagia, it is also a very common symptom of an every-day cold.

The Impacts of Dysphagia on Breastfeeding

The symptoms of dysphagia listed above may cause challenges with breastfeeding due to a disruption in the typical sucking pattern of a breastfeeding infant [5]. Disruption of the nutritive sucking pattern can result in issues not only for the breastfed infant, but also for the breastfeeding parent. For the infant, dysphagia and atypical sucking patterns at the breast can cause significant weight loss, aspiration (when the breast milk goes into the lungs), as well as an increase in infant stress and an overall negative association with breastfeeding [2]. For the breastfeeding parent, dysphagia in their breastfed infant can also cause nipple irritation and trauma, as well as a loss of milk supply. And similar to the infant, a threatened breastfeeding relationship due to dysphagia can cause anxiety and harm to the mental health of the breastfeeding parent [4]. The breastfeeding relationship is a bond that is often cherished by the breastfeeding parent, and while there are other viable options for feeding infants with dysphagia (such as tube feeding and bottle feeding) there are several strategies that can be utilized by parents who wish to maintain the breastfeeding relationship with their infant. 

Maintaining the Breastfeeding Relationship 

A diagnosis of dysphagia is not always followed by a recommendation to stop breastfeeding. In many cases, there are strategies that can be implemented to continue breastfeeding an infant with dysphagia. One of these strategies is to change the breastfeeding position. While not all breastfeeding relationships are the same, semi-reclined or side-lying positions are often the most effective in aiding parents breastfeed their infant with dysphagia. Another strategy that can be used while breastfeeding an infant with dysphagia is to adjust the flow rate of the breast milk. This can be done through methods such as applying pressure to the outer areola to inhibit the flow of milk from the milk ducts [4]. Changing breastfeeding positions and reducing milk flow to the infant can both greatly increase the chances of a successful breastfeeding relationship. 

Feeding at the breast, however, may not always be an option for infants with dysphagia. An infant’s healthcare provider may recommend temporarily utilizing feeding methods alternative to breastfeeding, like syringe or tube feeding. However, there are several other strategies that can be implemented to maintain the breastfeeding relationship for cases in which the infant may return to breastfeeding at a later time. For example, it is critical that the breastfeeding parent maintains their milk supply [4].

Maintaining milk supply can be done through either pumping or hand expressing. Sufficient milk production may also be encouraged by skin to skin contact between the breastfeeding parent and their infant, which can simultaneously enhance the bond between the lactating parent and the infant [3]. If milk production is successful, an additional method for maintaining the breastfeeding relationship is to provide breast milk to the infant via alternative feeding methods such as tube feeding and bottle feeding. For parents who are not yet able to lactate, the introduction of donated breast milk is a good alternative. Lastly, feeding from an empty or near-empty breast is an effective way of combining a number of the above suggestions, while also allowing for the infant to practice latching to the parent’s nipple [4].

Discussed throughout this article are several strategies for breastfeeding an infant with dysphagia. It is important to note that each breastfeeding parent and infant with dysphagia are unique. Because every infant is different and because the reasons for dysphagia may also vary, some strategies described above may not work for every case;  it is always suggested that breastfeeding parents consult and follow the advice of their healthcare provider.

Resources

• La Leche League Canada 
• Pediatric Dysphagia and Aspiration Facebook Support Group
• National Foundation of Swallowing Disorders (NFOSD) Pediatric Swallowing Facebook Support Group 
• Find a lactation consultant in your area
• Check your local hospital or health care center for additional resources

References

1. Krüger, E., Kritzinger, A., & Pottas, L. (2019). Oropharyngeal Dysphagia in Breastfeeding Neonates with Hypoxic-Ischemic Encephalopathy on Therapeutic Hypothermia. Breastfeeding Medicine, 14(10), 718–723. 
2. Arvedson, J. C. (2008). Assessment of Pediatric Dysphagia and Feeding Disorders: Clinical and Instrumental Approaches. Developmental Disabilities Research Reviews, 14(2), 118–127.
3. Yilmaz, F., Kucukoglu, S., Oezdemir, A. A., Ogul, T., & Aski, N. (2020). The Effect of Kangaroo Mother Care, Provided in the Early Postpartum Period, on the Breastfeeding Self-Efficacy Level of Mothers and the Perceived Insufficient Milk Supply. Journal of Perinatal and Neonatal Nursing, 34(1), 80–87.  
4. McGowan, C. (2020, December 15). Dysphagia and The Breastfed Infant [Lecture notes]
5. Glass, R. P., & Wolf, L. S. (1994). Incoordination of Sucking, Swallowing, and Breathing as an Etiology for Breastfeeding Difficulty. Journal of Human Lactation, 10(3), 185–189.